But, Doctor, It Doesn’t Seem Like the Depression I’ve Read About

Do these three statements sound familiar to you?

  • “I feel like I could sleep 23 hours a day and still not have enough rest.”
  • “I eat ALL the time.”
  • “My arms and legs feel like they are made of lead.”

If they do, you may be suffering from a form of depression known as atypical depression.

Depression is a common mood disorder, affecting nearly 17 million Americans. Far more than simply feeling blue, depression can negatively impact your life to such a degree that it becomes difficult to perform the normal tasks of daily living, such as working, keeping your house tidy or even taking care of your personal hygiene. Women are affected more often than men are, with nearly one in four experiencing a major bout of depression in their lifetimes. Depression is typically divided into two major categories- major depressive disorder and dysthymic disorder. Major depression tends to be more severe, but shorter lived and dysthymic depression is milder, but chronic.

For some sufferers, however, depression falls under a subcategory known as atypical depression. One of the primary things that distinguishes atypical depression from major depression and dysthymia is that people with atypical depression will often see their mood improve when their circumstances improve (called mood reactivity), which isn’t the case with chronic and severe depression. Other common characteristics associated with atypical depression include extreme oversleeping and overeating.

Diagnosing Atypical Depression

Atypical depression can be difficult to diagnose. The common criteria hinges on the mood reactivity, combined with at least two other symptoms from a list including oversleeping, overeating, feeling like your arms and legs are always very heavy (known as leaden paralysis), and interpersonal rejection sensitivity, or extreme sensitivity to personal rejection from other people.

Many doctors believe atypical depression is a type of dysthymia, meaning it can last at least two years or even longer. Other doctors suggest it may actually be a mild form of bipolar disorder, which used to be called manic depression, and is characterized by periods of depression alternating with periods of high energy and elevated, even extremely elevated moods. Regardless of which category this type of depression falls into, it is thought by many doctors to be quite under diagnosed.

How is it Treated?

Another distinction atypical depression has from other types of depression is the treatment. There are three main classes of antidepressant medications—MAOIs (monoamine oxidase inhibitors), TCIs (tricyclic antidepressants) and SSRIs (selective serotonin reuptake inhibitors.) MAOIs are the oldest, with TCIs becoming popular in the 1950s, and 1960s and SSRIs becoming the preferred treatment in the 21st century. With each new class of medication, the drugs became more effective, with fewer dangerous side effects. People with atypical depression don’t usually respond to TCIs or SSRIs, and are usually treated with MAOI type medications. MAOIs can cause a lot of problems, as they tend to cause many interactions with foods and other drugs, but unfortunately, they are still one of the best ways to treat this type of depression.

People with atypical depression have often been suffering since a much younger age than those with other kinds of depression, often since they were teenagers. Like other depressive disorders, doctors aren’t sure exactly what causes this lingering illness, but there seems to be a connection with a major loss in life, such as death or divorce, abuse, interpersonal conflicts, addictions, and even other serious illnesses like cancer, heart disease or HIV. Isolation from family or social groups and a family history of depression may also play a role.

Cognitive behavior therapies, along with medications and even some hormone treatments can work together to help those with atypical depression function much better and live a more productive, healthier, and happier life.

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